Monthly Archives: March 2013

Last Friday, March 15th, was “match day”–the day when medical students who are preparing to graduate find out where they have been matched for their residencies. It’s an interesting process. The medical students identify one or more specialty areas and rank their top programs–the places they’d be interested in spending the next several years continuing to hone their skills. At the same time, the residency programs at hospitals all across the country rank the students they’re interested in hiring. The “match” then sorts out the process in an effort to give everyone (the physicians and residency programs) their highest ranked option, moving down the list as slots are filled.

From the most recent match data, we know that out of the roughly 47,000 applicants, roughly 1 out of 4 matched into primary care residencies, including internal medicine, pediatrics and family medicine. This is an increase from last year, and marks the fourth year of increases in the primary care workforce. But the demand for primary care physicians continues to grow at a faster rate than we are able to produce them. One estimate suggests that we will experience a growing shortage of primary care physicians over the next decade, reaching a shortfall of 65,000 by the year 2025.

The Affordable Care Act makes some modest changes to increase the amount primary care physicians are paid, and it will take some time to realize the full impact of these policy changes, but for now, even the good news isn’t quite good enough, and the money isn’t going to training the primary care physicians, but is used to provide incentives for graduates to enter the field with more lucrative incomes once they enter into practice.

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Implementation of the Affordable Care Act continues to roll along, but more than that, the health care industry is doing a great job of coming up with loads of its own ideas. In the latest edition of the Health Wonk Review, David Williams presents the best health policy blogging of the last two weeks. Check it out here.

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Two weeks ago I wrote about some of the unintended, but positive, consequences that could result from employers dropping employer-sponsored health insurance (ESI). Following that post, many weighed in about various other consequences of such behavior from employers and what that means for health care coverage for millions of families in the US. One issue in particular caught my attention; not only because of the touching stories associated with the discussion, but because of the unique and inspiring methods some providers are utilizing to compensate for the lack of insurance coverage.

As Jodi Carroll of VoteFacts.org underscored, millions of women and men in the United States are reliant on their significant others employer to provide their family’s health insurance. Women, in particular, are disproportionately reliant on husband’s employers for coverage, with children who are also dependents.

Although there are positives that might ultimately develop in the individual market due to ESI, the current and near future are exceptionally frightening for many families and employers have started down that slippery slope by excluding many dependents from future insurance coverage.

Given the recent discussion in the media, spouses and children being dropped from employer coverage is a growing concern. In the context of a bloated and dysfunctional health care system, this significant and immediate alteration in health insurance coverage could be very difficult for many households to absorb financially, particularly if their income falls just above the threshold for federal subsidies to purchase policies in the upcoming health insurance exchanges.

But, what if these spouses and children had an option that could provide them with most of the services they need, and was easily accessible and affordable.

Throughout the nation, in response to shifts in health care, many small direct health care providers are opening shop. These direct providers are able to combat many concerns through price transparency, easy access and lower costs as they establish what is basically a menu of cash only services. Further, these one-on-one scenarios improve decision-making between patient and physician and take out the need for insurance and proof of citizenship.

While many services are not available through these direct providers, a bulk of what the majority of people need are. Chronic disease management, acute care services and preventative care are all available at a face value, affordable price.

Residents in North Carolina have embraced a shining example of this new system. Access HealthCare is a direct care provider in NC with results to be impressed by. One of their diabetic female patients, and her teenage son, had lost their health insurance when her husband them, taking his ESI with him. According to her KevinMD website interview, she was working two retail jobs to fund her diabetes treatment and medical, at a cost of $5,000 a year.

However, once she found Access Healthcare, her annual costs were reduced to $450 annually and her health care results improved.

Similarly, according to Dr. Brian Forrest, founder of Access Healthcare, “a patient who normally has an 80/20 plan (like Medicare Part B) might end up having to pay 20% of their fee to see a specialist for a stress echo. If the cardiologist I use gives them an 85% discount to just pay cash up front, then the patient actually spends less out of pocket by not using their insurance.”

Although not all medical care can be preventative or primary, Dr. Forrest contends that “only about 1% of the population gets hospitalized annually. Only about 5-10% of patients that seek care at a physician office cannot get the services they need in the outpatient setting.”

For now, most of what people need can be found in offices like those mentioned above. However, I would still encourage citizens to purchase, at minimum, catastrophic coverage for hospitalization.

Additionally, as we begin to see the intended and unintended consequences of the Affordable Care Act, it is vitally import that we are open to new ideas and creative methods for meeting the nations changing health care needs.